Orthopaedic infections: novel treatment strategies and evolving concepts

Orthopaedic infections remain challenging complications to treat, with profound economic impact in addition to patient morbidity. The overall rate of infection following orthopaedic surgery with internal fixation devices has been estimated at 5%, with hospital costs 8 times that of those without fracture-related infections and with significantly poorer outcomes regarding function and pain. Fracture-related infections (FRIs) occur in approximately 20% of all trauma cases, and treatment has evolved very little over the years. While union can be achieved 70%-89% of the time, long-term recurrence rates vary between 9% and 58% and retention of implants is only around 30%-40%. This is underscored by the financial, psychosocial, and physical burden placed on the patients. The difficult management of FRIs is multifactorial; however, a major contributor is biofilm. Alternative treatment strategies to combat biofilm have come in the form of photodynamic therapy and bacteriophage therapy. Use of local antibiotic therapy in the form of powder and dissolvable antibiotic beads has continued to be expanded, with new applications explored. Systemic antibiotic use has continued to be optimized, with new treatment protocols calling for per os (PO) administration as opposed to intravenous. In conclusion, orthopaedic infections remain difficult clinical dilemmas, although evolving prevention and treatment modalities continue to emerge.